Minority stress mediates associations of sexual minority state policies and tobacco use among US sexual minority young adults

Katelyn F Romm; Erin A Vogel; Christina Dyar; Laurie A Drabble; Patricia A Cavazos-Rehg; Carla J Berg

doi:10.1016/j.drugalcdep.2024.112477

Minority stress mediates associations of sexual minority state policies and tobacco use among US sexual minority young adults

Drug Alcohol Depend. 2024 Oct 23:265:112477. doi: 10.1016/j.drugalcdep.2024.112477. Online ahead of print.

Authors

Katelyn F Romm¹, Erin A Vogel², Christina Dyar³, Laurie A Drabble⁴, Patricia A Cavazos-Rehg⁵, Carla J Berg⁶

Affiliations

¹ TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA. Electronic address: [email protected].
² TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA. Electronic address: [email protected].
³ College of Nursing, The Ohio State University, Columbus, OH 43210, USA. Electronic address: [email protected].
⁴ School of Social Work, San José State University, San José, CA 95192, USA; Center for Applied Research in Human Services, College of Health and Human Sciences, San José State University, San José, CA 95192, USA. Electronic address: [email protected].
⁵ Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA. Electronic address: [email protected].
⁶ Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA; George Washington Cancer Center, George Washington University, Washington, DC 20052, USA. Electronic address: [email protected].

PMID: 39499991
DOI: 10.1016/j.drugalcdep.2024.112477

Abstract

Introduction: State policies surrounding sexual minority (SM) rights are associated with tobacco use among SM individuals. Research is scant regarding the role of distinct SM policy categories on SM young adults' (SMYAs) tobacco use and mechanisms explaining these associations.

Methods: We analyzed 2023 survey data from 1100 SMYAs (ages 18-34; 14.2 % gender minority; 66.1 % bisexual+, 29.1 % monosexual; 53.2 % racial/ethnic minority) with representation across 45 US states and DC. Regression-based models examined: 1) direct associations of residing in states with negative and limited (vs. comprehensive) SM state policies with respect to 7 policy categories (relationship/parent recognition, nondiscrimination, religious exemptions, LGBTQ youth, healthcare, criminal justice, gender identity documents) with minority stress (mental health, internalized stigma, community connectedness); 2) direct associations of policy categories and minority stress with tobacco use (past-month cigarette, e-cigarette, any tobacco use, number of products used); and 3) indirect associations of policy categories with tobacco use through minority stress.

Results: Relative to residing in states with comprehensive policies, residing in states with limited relationship/parent recognition policies indirectly predicted higher odds of e-cigarette use through mental health; weaker nondiscrimination policies indirectly predicted using more tobacco products through internalized stigma; and negative healthcare policies indirectly predicted higher odds of cigarette and any tobacco use through community connectedness.

Conclusions: These novel findings regarding associations among distinct SM policy categories, minority stress mediators, and tobacco use outcomes warrant further examination to better understand these distinct mechanisms, ultimately to inform SM-related policy and advocacy efforts, as well as tobacco prevention and cessation efforts.

Keywords: Minority stress; Policy; Sexual minority; Tobacco use; Young adults.